LA County Department of Mental Health Director Provides Updates at PPTFH Meeting

By SARAH SHMERLING | Editor-in-Chief

The Pacific Palisades Task Force on Homelessness welcomed distinguished speaker Jonathan Sherin, M.D., Ph.D., during its most recent online community meeting on May 24 to address “Ending the ‘Off & On’ Street Cycle of Severely Mentally Ill People.”

PPTFH Co-President Sharon Browning began the meeting by introducing Sherin, director of Los Angeles County Department of Mental Health, and touching on the fact that the subject of his talk was of high interest within the community.

“We are the ones that want to become engaged,” Browning shared. “We believe in collaboration and we very much want to work together to find change that can mutually benefit as many interests as possible.”

Browning explained that the Department of Mental Health, known as DMH, is the largest mental health system in the U.S., with a budget approaching $3 billion.

“Obviously this is a monster topic,” Sherin began. “We have a humanitarian crisis on our hands.”

He explained that though there are some industrialized-type communities that do not have a population of people experiencing homelessness, Los Angeles is a “far, far cry from that type of situation.”

“A community that is inclusive and that is well resourced is a place where individuals with any disability will actually be able to live their lives,” Sherin said. “In the context of people with severe mental illness, that would include a community with treatment, a community with opportunities for work or supportive employment, opportunities for housing.”

He continued to explain that one of the things he thinks is important for people to realize is that it’s not just treatment that people need, it is a combination of the things he listed.

“I like to call it the ‘people, place and purpose’ that every human being needs,” he said.

When it comes to DMH, Sherin explained that he is trying to build capacity in a couple of ways, one of which is crisis systems, which are real-time responders who will go and meet with people and get them to crisis-type treatment, including urgent care, hospitals, emergency departments and residential treatment.

“Unfortunately that system is woefully inadequate in Los Angeles and, frankly, all over the world, and certainly California and our country,” Sherin said, adding, “Our goal is really to create enough responders and enough places for people to go so that when crises occur, we can get people to treatment.”

When people fall out of communities, Sherin explained that they fall into asylums, such as living on the street or going to jail. He shared the importance of recognizing that there are different homeless populations and that the department is working hard to stratify the homeless population.

If he were asked to estimate the number of people experiencing homelessness that have “profound chronic mental illness,” meaning that condition is the reason why the person has fallen out of their community, Sherin would say that accounts for about 10%. He said that up to two-thirds of the homeless population may be living with mental illness, but oftentimes that is related to trauma and to what caused their homelessness, like the loss of a job.

“We’re reaching an inflection point,” Sherin said. “We all care about people, we’re all humanitarians. If you’re on this call, for one reason or another, you’re invested in this crisis.”

Sherin explained that he is not a fan of the term “gravely disabled,” defined in California as “an adult who, as a result of a mental disorder (rather than a chosen lifestyle or lack of funds) is unable to provide for his or her basic needs for food, clothing or shelter,” according to National Alliance on Mental Illness. He has put in about three years of work to replace the term.

Sherin then opened the meeting to the Q&A portion, taking questions from members of the audience and Browning, who opened with a question about asylums and where people can be placed to receive the treatment they need.

“My department, with help from a consultant, studied the bed shortage in Los Angeles County,” Sherin responded, adding that the county is about 4,000 treatment beds short, meaning it has about half of what it needs.

“We need to really bring back the open residential treatment facilities of yesteryear, which are welcoming,” Sherin continued. “Would it not be great if people who had a profound mental illness and their families could actually take someone to get extended type residential care, like they would for a physical condition, and that treatment would be accepted?”

He reported that one of the issues is needing more funding to sustain beds, including examining incoming funds related to COVID-19 relief and seeing if the department is able to use them for work of this nature.

Sherin touched on the IMD Exclusion waiver and repeal, which he said is ultimately a “bigger thing” because those would be sustained funds that pour in “year after year after year.”

“Currently, the law prohibits states from using Medicaid to pay for care provided in ‘institutions for mental disease’ (IMDs), which are psychiatric hospitals or other residential treatment facilities that have more than 16 beds,” according to NAMI. “Recently, states were given the option to cover short-term stays in psychiatric hospitals by applying for a waiver from the federal government.”

One of the questions PPTFH posed to Sherin related to his thoughts on people who need treatment but refuse to accept it.

“This is a lightning rod question and it’s one that gets to the heart of autonomy versus internalism,” he explained. “We must, in a very robust and relentless way, put our best feet forward to offer resources to that person for a significant amount of time before we move to infringing upon civil liberties.”

He continued on to say that the goal is to help people recover and not to put them on conservatorship indefinitely.

When asked about locations to house people in the county and beyond, Sherin responded that it has to be done with “deep respect and intentionality” as to not provoke a different type of public health or public safety risk.

“It has to be done with the entire collective in mind, as well as the individual people who are suffering in our streets,” he explained, adding that while he won’t start pointing at specific locations, places that have existing infrastructure have “major advantages”—although he does not believe facility-based solutions are the only kind.

“What’s fair?” Sherin continued. “I’m not trying to weigh on one side or another, I’m just saying we have to make decisions that are strategic that we can commit to and recognize that every one of us is probably going to have to make some kind of concession in order for our collective problem to be solved by the collective.”

A full replay of the community meeting webinar is available at pptfh.org.